PROJECT SUMMARY/ABSTRACT More than a third of dementia cases may be preventable by addressing risk factors across the life-course, with hearing loss identified as the most likely modifiable risk factor. Recent studies suggest that hearing loss is associated with faster cognitive decline and risk of dementia, but the specific underlying mechanisms are not well understood. A potential explanation for part of the relationship between hearing loss and cognitive decline is health literacy. Low health literacy has been associated with both hearing loss and cognitive decline and could be an important causal link in this relationship. Yet, there remains a lack of validated cognitive assessment and health literacy tools for older adults with hearing loss. The proposal aims to address these gaps by validating cognitive (i.e. NIH ToolBox Cognition Battery) and health literacy assessment tools in addition to examining the relationship of health literacy with cognitive decline among individuals 65 years and older with hearing loss. We hypothesize that health literacy assessments may provide an early clue or document a risk for Alzheimer?s Disease and Related Dementia (ADRD), including mild cognitive impairment (MCI) in this population. This may allow for aggressive risk factor modification to slow down potential cognitive decline. This may include but not be limited to: hearing amplification, hearing aids, lifestyle modification, disease management, and promotion of accessible health curriculum. Developing accessible cognitive assessment and health literacy tools for this group will help hearing loss researchers and clinicians to appropriately assess for cognitive decline and health literacy adequacy in at-risk populations. Work currently in progress on the parent grant has found different strengths of associations between health literacy and reading literacy, cognition, language fluency, and information-seeking and interpretation ability in the deaf population when compared to the hearing population. The supplement will expand our ability to examine the potential role of health literacy with MCI and ADRD in older adults with hearing loss. Three specific aims are proposed. Aim 1 will validate cognitive and health literacy assessment tools for their use among older individuals with hearing loss. Aim 2 will assess health literacy as an effect modifier of the association between hearing loss and mild cognitive impairment in a group of older adults with hearing loss. Aim 3 will examine the role of health literacy on the uptake of hearing aids as a potential modifiable factor among older adults with hearing loss.